Abnormal Liver Function Tests

HISTORY:

Presents for ‍abnormal liver function tests

Lab results:

ALT ‍, AST ‍, ALP ‍, GGT ‍

Bilirubin ‍, Albumine ‍, INR ‍

‍fatigue

‍nausea

‍loss of appetite

‍unexpected weight loss

‍fever

‍abdominal swelling

‍abdominal pain

‍jaundice

‍leg swellings

‍dark colored urine

‍dark, tarry stool



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Non-alcoholic fatty liver disease ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍Hba1c, ‍lipid profile, ‍LFTs, ‍bilirubin, ‍albumin, ‍proteins, ‍prothrombin time, ‍INR, ‍ferritin, ‍iron, ‍TIBC, ‍anti-HBs antibodies, ‍HBsAg, ‍anti-HBc antibodies, ‍anti-HCV antibodies

- Blood work (advanced): ‍anti-transglutaminase antibodies, ‍anti-mitochondrial antibodies, ‍anti-nuclear antibodies, ‍anti-smooth muscle antibodies, ‍anti-KLM antibodies, ‍alpha-1 antitrypsin, ‍ceruloplasmin

- Abdominal ultrasound

- Liver biopsy

- Avoidance of alcohol

- Weight loss counseling

- Dietary modifications: ‍low fat diet, ‍high fiber diet

- Reassess medications that may be causing liver damage (acetaminophen, statins, antibiotics, antifungals, immunosuppressants, chemotherapy drugs, herbal supplements)

- Repeat LFTs in ‍ ‍daysweeks

- Referral to gastroenterologist

- Referral to hepatologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen or if new symptoms develop such as jaundice, abdominal pain, or fever